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    Spina Bifida

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    M Isyhaduul Islam
    Spina bifida is a birth defect where there is an opening in the spinal column, the most severe form being myelomeningocele. Children with myelomeningocele often have disabilities like paralysis and learning problems. The MOMS Study showed that prenatal surgery to repair the defect between 19-26 weeks of pregnancy significantly reduced complications and improved outcomes compared to postnatal surgery. Fetal surgery involves making a small incision in the mother's uterus to close the opening while the fetus remains in the womb.

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    Spina Bifida

    Uploaded by

    M Isyhaduul Islam
    175 views1 page
    Spina bifida is a birth defect where there is an opening in the spinal column, the most severe form being myelomeningocele. Children with myelomeningocele often have disabilities like paralysis and learning problems. The MOMS Study showed that prenatal surgery to repair the defect between 19-26 weeks of pregnancy significantly reduced complications and improved outcomes compared to postnatal surgery. Fetal surgery involves making a small incision in the mother's uterus to close the opening while the fetus remains in the womb.

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    Spina bifida is a birth defect where there is an opening in the spinal column, the most severe form being myelomeningocele. Children with myelomeningocele often have disabilities like paralysis and learning problems. The MOMS Study showed that prenatal surgery to repair the defect between 19-26 weeks of pregnancy significantly reduced complications and improved outcomes compared to postnatal surgery. Fetal surgery involves making a small incision in the mother's uterus to close the opening while the fetus remains in the womb.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    175 views1 page

    Spina Bifida

    Uploaded by

    M Isyhaduul Islam
    Spina bifida is a birth defect where there is an opening in the spinal column, the most severe form being myelomeningocele. Children with myelomeningocele often have disabilities like paralysis and learning problems. The MOMS Study showed that prenatal surgery to repair the defect between 19-26 weeks of pregnancy significantly reduced complications and improved outcomes compared to postnatal surgery. Fetal surgery involves making a small incision in the mother's uterus to close the opening while the fetus remains in the womb.

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    Spina Bifida

    Fetal Surgical Repair of Myelomeningocele


    Spina bifida is a congenital defect consisting of an opening in the spinal
    column. The most severe form is called myelomeningocele. Most children
    with this birth defect survive, but can be left with many disabilities, including
    paralysis, difficulty with bowel and bladder control, Chiari II malformation,
    hydrocephalus (excessive fluid in the brain), and learning disabilities. The
    higher the spinal opening occurs on the back, the greater the impairment.
    Treatment
    Infants with myelomeningocele have always had surgery shortly after birth
    to protect the spinal cord by closing the normal tissues of the back. Often,
    a ventriculoperitoneal (VP) shunt was also placed to treat hydrocephalus.
    Due to the success of the MOMS Study, fetal surgery is now considered to
    be a treatment option for some cases of myelomeningocele.
    What is the MOMS Study?
    MOMS Study is a NIH-sponsored multicenter clinical trial evaluating the
    best treatment for myelomeningocele: fetal surgery or surgery after birth.
    The trial results showed prenatal surgery significantly reduced the need to
    divert, or shunt, fluid away from the brain; improved mental development
    and motor function; and increased the likelihood for a child to walk unassisted. The trial proved some of the problems, like Chiari II malformation
    and hydrocephalus, develop during the second half of pregnancy. Repairing the defect early may allow some nerve function to be restored in
    pregnancy, and reverse the development of condition.
    Fetal Surgery
    Prenatal repair of myelomeningocele involves a multidisciplinary team of
    fetal surgey experts. An incision, just large enough to repair the defect, is
    made in the mothers abdomen and uterus.
    This is much like a cesarean section but the
    fetus remains in the womb. The neural tube
    and other layers of the back are surgically
    closed by the neurosurgeon. After the procedure, the incisions in the mother are closed.
    Recovery
    After surgery, patients will remain in the hospital for 45 days, cared for by
    skilled nurses with years of experience in fetal surgical care and the fetus
    will be monitored via ultrasound. Upon hospital discharge, the mother is
    required to stay locally for at least 10-14 days. Travel home is determined
    by the mother's condition and the availability of medical services.
    Components of UCSF Evaluation
    Level II anatomic survey for fetal anomalies
    Fetal echocardiagraphy for structural integrity and functional pathology
    Fetal brain/spine MRI for presence and severity of Chiari II Malformation
    Consultation with our multidisciplinary team: anesthesia, fetal surgery,
    neurosurgery, nursing, perinatology, neonatology, and social work
    How to Make an Appointment or Referral
    Patients who wish to consider fetal surgery at UCSF for the treatment of
    spina bifida, and providers making a referral please call us at 1-800-RXFETUS. Patient medical records should be faxed to 415-502-0660.
    More info is available at: http://fetus.ucsfmedicalcenter.org/spina-bifida

    Normal Anatomy
    Cerebrum
    Ventricles
    Cerebellum
    Brain Stem
    Spinal Cord

    Myelomeningocele
    Hydrocephalus
    Build up of CSF
    compresses brain
    Chiari II Malformation
    Back of brain is pulled
    down out the skull into
    top of the spinal canal
    Myelomeningocele
    Protruding meninges
    and spinal cord

    After Fetal Surgery


    Hydrocephalus
    Decreased need for
    shunt
    Improved
    Chiari II Malformation
    Brain moves back into
    more normal position
    Protected
    Myelomeningocele
    Spinal cord protected

    Inclusion Guidelines
    Myelomeningocele defect must start between
    T1-S1 (may extend below S1)
    Chiari II malformation by MRI
    Normal fetal karyotype
    Gestational age at referral between 19 to 26 weeks
    Exclusion Guidelines
    Multifetal pregnancy (twins, triplets, etc)
    Maternal contraindications to surgery or anesthesia
    Morbid obesity
    Kyphosis (curve in the spine) in the fetus 30
    Other fetal problem not related to the spina bifida
    Current or planned cerclage or documented history
    of incompetent cervix
    Short cervix (< 20 mm)
    Preterm labor in the current pregnancy
    Placenta previa or placental abruption
    Maternal-fetal isoimmuization
    Uterine anomaly
    Inability to comply with travel or follow-up

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